Drugs Requiring Prior Authorization



Certain medications require prior authorization. Your pharmacist will help you arrange for these drugs. Physicians must call Express Scripts.

Narcotic analgesics are subject to prior authorizations and state regulations.

Express Scripts’ prior authorization (PA) policies include the brand medication and any available generics for that brand.

Express Scripts

(800) 753-2851 — Physicians only

Oncology Treatment

Call eviCore at (888) 910-1199.

Drug Classes Requiring Approval by the Benefit Fund

  • Factor VIII blood factor products
  • Rare diseases (e.g. Fabry’s Disease, Gaucher’s Disease)

View a complete list of drug classes requiring approval by the Benefit Fund.

Call the Benefit Fund at (646) 473-7446.

Subject to Change

Drugs Requiring Prior Authorization Effective July 2018

Drug TargetTherapy Class
AbstralPain - Narcotic
Actemra IVInflammatory Conditions
Actemra SCInflammatory Conditions
ActiqPain - Narcotic
AdcircaPulmonary Hypertension
Adderall XRAttention Disorders
AdempasPulmonary Hypertension
amphetamine sulfateAttention Disorders
AmpyraMultiple Sclerosis
anabolic steroidHormone Supplementation
AndrodermEndocrine Disorder
AndroGelEndocrine Disorder
Aptensio XRAttention Disorders
Aralast NPMetabolic, Immune Disorders or Inherited Rare Disease
AranespBlood Cell Deficiency
ArcalystMetabolic, Immune Disorders or Inherited Rare Disease
Atralin gel Skin Conditions
AubagioMultiple Sclerosis
AustedoNeurological Disorders
AveedEndocrine Disorder
AvitaSkin Conditions
AvonexMultiple Sclerosis
AxironEndocrine Disorder
BelviqWeight Loss
BenlystaMetabolic, Immune Disorders or Inherited Rare Disease
Benzphetamine HclWeight Loss
BerinertMetabolic, Immune Disorders or Inherited Rare Disease
BetaseronMultiple Sclerosis
BivigamMetabolic, Immune Disorders or Inherited Rare Disease
BotoxNeurological Disorders
BunavailPain - Narcotic
BydureonDiabetes
ByettaDiabetes
CarimuneMetabolic, Immune Disorders or Inherited Rare Disease
CaverjectImpotence
Caverject ImpluseImpotence
CaystonAnti-infectives
ChemetChelating Agents
ChenodalMetabolic, Immune Disorders or Inherited Rare Disease
CholbamMetabolic, Immune Disorders or Inherited Rare Disease
CimziaInflammatory Conditions
CinqairAsthma Specialty
CinryzeMetabolic, Immune Disorders or Inherited Rare Disease
ConcertaAttention Disorders
Contrave Weight Loss
CopaxoneMultiple Sclerosis
CopegusHepatitis C
CorlanorHeart Failure
CosentyxInflammatory Conditions
DaklinzaHepatitis C
DalirespBlood Cell Deficiency
Daraprim Metabolic, Immune Disorders or Inherited Rare Disease  
DaytranaAttention Disorders
Delatestryl Endocrine Disorder
Depo - Testosterone Endocrine Disorder
DesoxynAttention Disorders
Dexedrine SpansulesAttention Disorders
dexmethylphenidate HCLAttention Disorders
dextroamphetamine sulfateAttention Disorders
dextroamphetamine sulfate tabletsAttention Disorders
diclofenac sodiumSkin Conditions
DificidAnti-infectives
DupixentSkin Conditions
Dyanavel XRAttention Disorders
DysportNeurological Disorders
EdexImpotence
EgriftaEndocrine Disorder
EligardEndocrine Disorder
EmflazaMetabolic, Immune Disorders or Inherited Rare Disease
EnbrelInflammatory Conditions
EndariMetabolic, Immune Disorders or Inherited Rare Disease  
EntrestoHeart Failure
EntyvioInflammatory Conditions
EpclusaHepatitis C
EpogenBlood Cell Deficiency
epoprostenol sodium Pulmonary Hypertension
EsbrietRespiratory Miscellaneous
EuflexxaOsteoarthritis
EvekeoAttention Disorders
ExjadeIron Chelators
ExtaviaMultiple Sclerosis
EyleaEye Conditions
Fabior 0.1% foam Skin Conditions
fentanylPain - Narcotic
FentoraPain - Narcotic
FerriproxIron Chelators
FirazyrMetabolic, Immune Disorders or Inherited Rare Disease
Flebogamma DIFMetabolic, Immune Disorders or Inherited Rare Disease
FlolanPulmonary Hypertension
FocalinAttention Disorders
Focalin XRAttention Disorders
ForteoBone Conditions
FortestaEndocrine Disorder
GammagardMetabolic, Immune Disorders or Inherited Rare Disease
Gammagard LiquidMetabolic, Immune Disorders or Inherited Rare Disease
Gammagard S/DMetabolic, Immune Disorders or Inherited Rare Disease
GammakedMetabolic, Immune Disorders or Inherited Rare Disease
GammaplexMetabolic, Immune Disorders or Inherited Rare Disease
GamunexMetabolic, Immune Disorders or Inherited Rare Disease
Gamunex-CMetabolic, Immune Disorders or Inherited Rare Disease
Gel-OneOsteoarthritis
GenotropinEndocrine Disorder
GenviscOsteoarthritis
GilenyaMultiple Sclerosis
GlassiaMetabolic, Immune Disorders or Inherited Rare Disease
GlatopaMultiple Sclerosis
GocovriNeurological Disorders
GranixBlood Cell Deficiency
GrastekAllergies
H.P. Acthar GelMetabolic, Immune Disorders or Inherited Rare Disease
HarvoniHepatitis C
HetliozSleep Disorder
HizentraMetabolic, Immune Disorders or Inherited Rare Disease
HumatropeEndocrine Disorder
HumiraInflammatory Conditions
HyalganOsteoarthritis
HymovisOsteoarthritis
HyqviaMetabolic, Immune Disorders or Inherited Rare Disease
ibandronate sodiumBone Conditions
IlarisMetabolic, Immune Disorders or Inherited Rare Disease
IncrelexEndocrine Disorder
InflectraInflammatory Conditions
IngrezzaNeurological Disorders
JuxtapidHigh Blood Cholesterol
KalbitorMetabolic, Immune Disorders or Inherited Rare Disease
KalydecoRespiratory Miscellaneous
KeveyisMetabolic, Immune Disorders or Inherited Rare Disease
KevzaraInflammatory Conditions
KineretInflammatory Conditions
KorlymEndocrine Disorder
KrystexxaGout
KuvanMetabolic, Immune Disorders or Inherited Rare Disease
KynamroHigh Blood Cholesterol
LazandaPain - Narcotic
LemtradaAsthma/COPD
LetairisPulmonary Hypertension
LidocainePain
Lovaza High Blood Cholesterol
LucentisEye Conditions
LupanetaEndocrine Disorder
Lupron DepotEndocrine Disorder
Lupron Depot-PedEndocrine Disorder
MacugenEye Conditions
MakenaHormone Supplementation
Metadate CDAttention Disorders
Metadate ERAttention Disorders
MethylinAttention Disorders
methylphenidateAttention Disorders
methylphenidate ERAttention Disorders
methylphenidate HCLAttention Disorders
MirceraBlood Cell Deficiency
modafinilNarcolepsy
Moderiba Hepatitis C
MonoviscOsteoarthritis
MuseImpotence
MyaleptEndocrine Disorder
MyoblocNeurological Disorders
NatestoEndocrine Disorder
NatparaEndocrine Disorder
NeulastaBlood Cell Deficiency
NeupogenBlood Cell Deficiency
Norditropin Endocrine Disorder
NortheraNeurological Disorders
NplateMetabolic, Immune Disorders or Inherited Rare Disease
NucalaAsthma Specialty
NuedextaNeurological Disorders
Nutropin AQ Nuspin Endocrine Disorder
NuvigilNarcolepsy
OcalivaMetabolic, Immune Disorders or Inherited Rare Disease
OcrevusMultiple Sclerosis
OctagamMetabolic, Immune Disorders or Inherited Rare Disease
OfevRespiratory Miscellaneous
OmnitropeEndocrine Disorder
OnsolisPain - Narcotic
OpsumitPulmonary Hypertension
OralairAllergies
OrenciaInflammatory Conditions
OrenitramPulmonary Hypertension
OrkambiRespiratory Miscellaneous
OrthoviscOsteoarthritis
OtezlaInflammatory Conditions
PegIntronHepatitis C
PhendimetrazineWeight Loss
Phentermine HclWeight Loss
PlegridyMultiple Sclerosis
Praluent High Blood Cholesterol
PrivigenMetabolic, Immune Disorders or Inherited Rare Disease
ProcentraAttention Disorders
ProcritBlood Cell Deficiency
ProlastinMetabolic, Immune Disorders or Inherited Rare Disease
Prolastin CMetabolic, Immune Disorders or Inherited Rare Disease
ProliaBone Conditions
PromactaMetabolic, Immune Disorders or Inherited Rare Disease
ProvigilNarcolepsy
QsymiaWeight Loss
Quillichew ERAttention Disorders
Quillivant XRAttention Disorders
RagwitekAllergies
RebetolHepatitis C
RebifMultiple Sclerosis
RemicadeInflammatory Conditions
RemodulinPulmonary Hypertension
RepathaHigh Blood Cholesterol
RestasisEye Conditions
Retin-ASkin Conditions
Retin-A Micro Skin Conditions
RevatioPulmonary Hypertension
RibasphereHepatitis C
RibavirinHepatitis C
RitalinAttention Disorders
Ritalin LAAttention Disorders
Ritalin SRAttention Disorders
RituxanInflammatory Conditions
RuconestMetabolic, Immune Disorders or Inherited Rare Disease
SaizenEndocrine Disorder
SamscaEndocrine Disorder
Sanorex Weight Loss
SaxendaWeight Loss
SelzentryHIV
SensiparEndocrine Disorder
SerostimEndocrine Disorder
Signifor/Signifor LAREndocrine Disorder
Simponi/Simponi Aria Inflammatory Conditions
SivextroAnti-infectives
Solaraze Skin Conditions
SolirisMetabolic, Immune Disorders or Inherited Rare Disease
SovaldiHepatitis C
SpinrazaMetabolic, Immune Disorders or Inherited Rare Disease
StelaraInflammatory Conditions
StriantEndocrine Disorder
SuboxonePain - Narcotic
Subsys Pain - Narcotic
SupartzOsteoarthritis
SymdekoRespiratory Miscellaneous  
SymlinDiabetes
SynagisRespiratory Miscellaneous
SynviscOsteoarthritis
Synvisc-OneOsteoarthritis
SyprineMetabolic, Immune Disorders or Inherited Rare Disease
TaltzInflammatory Conditions
Tazorac 0.05% and 0.1% cream, gel Skin Conditions
TecfideraMultiple Sclerosis
TechnivieHepatitis C
Tenuate Weight Loss
TestimEndocrine Disorder
Testopel Endocrine Disorder
tetrabenazineNeurological Disorders
TracleerPulmonary Hypertension
Tretin X Skin Conditions
tretinoin topical productsSkin Conditions
TrulicityDiabetes
TysabriMultiple Sclerosis
TyvasoPulmonary Hypertension
UptraviPulmonary Hypertension
VascepaHigh Blood Cholesterol
VeletriPulmonary Hypertension
Veltin Skin Conditions
VentavisPulmonary Hypertension
VictozaDiabetes
ViekiraHepatitis C
Viekira XRHepatitis C
VprivMetabolic, Immune Disorders or Inherited Rare Disease
VyvanseAttention Disorders
XeljanzInflammatory Conditions
Xeljanz XRInflammatory Conditions
Xenical Weight Loss
XeominNeurological Disorders
XermeloGastrointestinal
XiidraEye Conditions
XolairAsthma Specialty
Zarxio Blood Cell Deficiency
ZavescaMetabolic, Immune Disorders or Inherited Rare Disease
ZemairaMetabolic, Immune Disorders or Inherited Rare Disease
ZenzediAttention Disorders
ZepatierHepatitis C
ZianaSkin Conditions
ZinbrytaMultiple Sclerosis
zoledronic acid/mannitol & waterBone Conditions
ZomactonEndocrine Disorder
ZorbtiveEndocrine Disorder
ZubsolvPain - Narcotic
ZyvoxAnti-infectives